Why Health Information Exchange is Important for EHR Use

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Why Health Information Exchange is Important for EHR Use

Health Information Exchange is Important for EHR Use

Electronic Health Records (EHRs) are an integral part of today’s healthcare system. Despite initial hesitation to switch to an EHR, an overwhelming majority of organizations that have made the change cannot imagine going back to paper. EHRs improve efficiency and increase reimbursements while improving patient care. As providers become more fluent with the technology, EHRs help them with decision making and influence the way a client is treated. Additionally, EHRs enable connectivity, or to use the current buzzword, interoperability.

Interoperability refers to health information technology that enables electronic health information to be easily exchanged. It lets authorized professionals access, exchange and use the health information. In our journey to transform healthcare, Health Information Exchanges (HIEs) have been established. Connecting an EHR to an HIE allows health information to flow seamlessly to the right people at the right place at the right time.

What is an HIE?

But what exactly is an HIE? Historically, when a patient visited a healthcare facility, the provider had two paths to understand the medical history of the patient:

  • Check the facility’s own EHR system for prior visit information, such as allergies, medications, procedures, etc.
  • Ask the patient to fill in any missing information not already documented.

As you know, there are several problems with this process. Not only do patients rarely remember information from prior visits, but they are seen in multiple facilities using various EHR systems, as well. Also, consider a patient who comes into the ER and is unresponsive. How would a provider find out about his or her missing information?

A Health Information Exchange addresses this issue. An HIE is a secure central repository of patient data aggregated across multiple facilities and EHR systems in the same region. The goal is to provide a holistic view of the patient’s electronic health record through a secure, standardized system. EHRs connected to an HIE can share information via the federally defined standards of CCR (Continuity of Care Record) and CCD (Continuity of Care Document). This is the standard all federally-certified EHRs must follow.

Any federally-certified EHR connected to an HIE can (if permitted) send and/or receive information between the EHR and the HIE. Thus, the provider can send and receive electronic information with any community provider also connected to the HIE.

Benefits of Health Information Exchange

Benefits of Using an EHR for Health Information Exchange

Using an HIE streamlines information and connects a practitioner to all aspects of a client’s medical history. Practitioners can receive health information from the HIE, such as a patient discharge summary from a community hospital. This information can be brought into a patient’s chart as electronic health data after it has been reviewed. Using an HIE helps facilitate coordinated patient care, enabling an organization to:

  • Save time by minimizing readmissions
  • Increase efficiency by moving away from paper and fax machines
  • Save money by avoiding duplicate testing
  • Provide clinical decision support tools to improve care and treatment
  • Minimize medication and medical errors
  • Engage consumers about their own personal health information
  • Improve healthcare quality and outcomes.

HIEs reduce the amount of time patients spend completing paperwork and briefing their providers on their medical history. This frees up more time for discussions about health concerns and treatments between the patient and provider. By saving time for patients and providers along the continuum of healthcare delivery, HIEs have the potential to both reduce costs and improve health outcomes.

Health Information Exchange Challenges

The push for nationwide interoperability and improved health data exchange have increased HIE and EHR use. In some cases, organizations have been mandated to make the adoption. But, that doesn’t mean HIE connectivity doesn’t come without challenges.

HIE and Data Security

One of the biggest concerns with HIEs is ensuring health data privacy and security are maintained throughout the entire data exchange process. Participating organizations must follow all federal and state requirements related to data security, but they still need to allow information to be exchanged freely for patient care. While information exchange between EHR systems and HIEs is HIPAA compliant, the growing number of cybersecurity attacks have piqued concern about health data security.

A 2017 Black Book survey confirmed these fears extend to patients. Patients surveyed were nervous their digital health information might be shared beyond their physician and hospital. Furthermore, they are not confident their physician will be able to keep their personal information secure. 69% felt their primary care physician “does not demonstrate enough technology prowess” to reassure them that their data is safe.

Physician Burnout

Another major challenge HIE connectivity brings to the forefront is information overload. Physicians are already experiencing burnout. Providers are further burdened with copious amounts of data flooding them, which can lead to less effective care.

While the Patients Over Paperwork initiative is promising to reduce administrative burden and physician burnout, it doesn’t fully account for the volume of data providers will be faced with.

Many providers have lamented that their EHR system is not built with an easy to use clinical workflow. Adding another step to incorporate data from an HIE is just that – another step.

Regardless of the challenges, EHRs and HIEs aren’t going away. They are a major part of the digitization of healthcare and the shift toward value based care. Learning to utilize these tools effectively will help your organization provide more streamlined, effective patient care. And, of course, we recommend working with an EHR vendor who will help you navigate this process with training, support and best practices!



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North Carolina Requires Opioid E-Prescribe

The North Carolina Medical Board recently released a new mandate for the Strengthen Opioid Misuse Prevention (STOP) Act of 2017. Starting in January, North Carolina agencies prescribing opioids and narcotics will be required to submit prescriptions electronically. This e-prescribe requirement is for targeted controlled substances, which include Schedule II and Schedule III opioids and narcotics. Targeted controlled substances is a category originally created by the STOP Act in 2017. The NC Medical Board created a complete list of substances requiring electronic prescriptions.

What is the STOP Act?

Signed by Gov. Roy Cooper in 2017, the STOP Act was intended to address the opioid crisis in North Carolina. The state hoped this act would reduce excessive and inappropriate opioid prescribing. Primary components of the STOP Act include prescribing limits and requirements for the NC Controlled Substances Reporting System (CSRS). Other provisions mandated in the act impact licensed professionals who prescribe controlled substances. For example, Physician Assistants and Nurse Practitioners must consult with a superior physician before prescribing a targeted controlled substance.

Statistics of Opioid Use in North Carolina

In order to understand the STOP Act, the opioid crisis in North Carolina must also be understood. According to the North Carolina Department of Health and Human Services, here are some statistics on the issue:

  • 445,002,000 opioid pills were dispensed to North Carolina residents in 2018
  • 1,718 NC residents died from an unintentional opioid overdose in 2018
  • 5 North Carolinians died each day in 2018 from unintentional opioid overdose
  • More than 14,500 people in NC died because of an unintentional opioid overdose from 1999 to 2018


Exemptions for E-Prescribe

The STOP Act notes multiple instances where the e-prescribe requirement will be exempt. The following exemptions are specified:

  1. A clinician (other than a pharmacist) who dispenses to an ultimate user
  2. Clinicians who prescribe controlled substances administered in a hospital, nursing home, hospice facility, outpatient dialysis facility, or residential care facility.
  3. A clinician that experiences technological outages or failures. In this instance, clinicians must document the reason for exemption in the client’s medical record.
  4. A clinician who prescribes medication dispensed by a pharmacy on federal property. In this instance, clinicians must document the reason for exemption in the client’s medical record.
  5. Professional who practices veterinary medicine

These are the only exemptions for the e-prescribe requirement. If a practitioner does not currently e-prescribe, they must start in January 2020. The NC Medical Board does not find it acceptable for any practitioner to refer a patient to a hospital emergency room in January because they did not receive e-prescribe capabilities. Therefore, anyone who prescribes targeted controlled substances must begin the e-prescribing by the beginning of the new year.

How to E-prescribe Controlled Substances

Electronic Prescribing for Controlled Substances (EPCS) allows professionals to prescribe Schedule II-V controlled substances directly from point-of-care to pharmacy. E-prescribing is accurate, comprehensive, and secure. Under the Drug Enforcement Administration’s (DEA) regulations, EPCS has strict requirements. DEA’s strict rules work to verify prescribers and avoid errors to patients. Verification is conducted through identity proofing and 2nd-factor authentication. Although these rules make e-prescribing more complex, they work to decrease opioid misuse.

Often, electronic prescribing services are available within the prescriber’s EHR. When selecting an EHR, it is important to consider how its e-prescribing functionality meets the DEA’s complex regulations for EPCS. Consider asking about and researching your EHR’s electronic prescribing service. Patagonia Health integrates EPCS in our easy-to-learn solution. To learn more about how Patagonia Health can help you comply with the STOP Act, contact us today.

Ten Indicators That You Should Replace and Modernize Your EHR System

Ten indicators that you should replace and modernize your Electronic Health Record (EHR). If your agency has three of these indicators, you should search for another EHR.


Not all EHRs are created equally. Some are archaic and cumbersome, and require too much IT support. Some are expensive and yet still do not do everything that you need them to do. Does this sound like your current EHR System? Here are 10 indicators that are telling you it is time to look elsewhere. If you have three of these indicators, it is time to start Googling new EHR.


  1. Your staff is constantly complaining about your current EHR being too cumbersome to use.
  2. Your IT and clinical staff are spending months and years to build your EHR. After years, you still cannot capture charts electronically. Even borrowing templates from other clinics is not helping. Your EHR should work out of box from day 1.
  3. Billing and getting paid is an enormous challenge. Expanding to other payers is complex.
  4. Staff is tired of having to go to multiple screens to do even simple tasks requiring dual data entry.
  5. You need an IT guru to pull even simple reports – and even then, the reports are not accurate or complete.
  6. Your agency has yet to achieve meaningful use compliance. Are you shocked how much more you have to pay for upgrade to meaningful use stage 1 or stage 2? What will it cost you to upgrade to Meaningful use stage 3 coming in 2016?
  7. Connectivity to required Immunization Registry or Health Information Exchange is cumbersome or expensive.
  8. You’re tired of the never-ending purchases of this or that module – and you still do not have everything you need?
  9. Service from your current EHR vendor is non-existent – it takes months or years to get an enhancement your staff needs to do their day-to-day job. Your vendor is not focused to meet your needs.
  10. In your heart, you know that putting more effort into a 20+ year old software is not going to get you there, and yet, you continue year after year, because other agencies you know have same bad software.

If your organization has 3 or more of the above indicators, you should seriously check out other modern software. With federal meaningful use standards, switching to another EHR is not hard to do. You may also save some $s.

Will your staff use and adopt your new Electronic Health Record EHR software?

Easy EHR



There are stories of new EHRs being bought and not used by the staff. Why is that? How do you make sure the EHR you select will get used? In one of our previous blog articles we discussed the 7+1 bonus steps for EHR selection. The most important +1 bonus talked about ease-of-use. Ease-of-use really is a critical step if you want your chosen EHR system to reap the benefits that it should provide.


When I talk about ease-of-use, I don’t mean simply that the program is easily navigated, but it should also fit well into your organization. Let me explain further by addressing two critical areas for a new EHR adoption: staff and workflow.


Staff: The question to ponder before choosing your EHR should be “To what degree is the system usable for ALL of our staff?” Your staff no doubt includes the tech savvy and not so tech-savvy, the veterans and the newbies, the change-accepting and change-averse. Many nurses, for example, have been nursing for many years, and are now being asked to change their world dramatically with the EHR. They are “people” people, not computer geeks. The new EHR must be easy-to-use and have buy-in of all your staff. Thus, your EHR software should:


  1. Be easy-to-learn, easy-to use. Does it utilize familiar features of other technology that most of your staff is already used to (such as surfing the web and mobile apps). Is the EHR software web based and use similar patterns as they are used to on other web sites (such as Amazon™, Facebook™ or Google™). Or was the EHR program written in the 80s and 90s? Before internet, old software was written with IT users or geeks in mind. Whereas, newer web software such as the one your staff is surfing is designed for average consumer and not an IT guru. So make sure you go with latest web and apps based EHR as it be easy-to-use and learn.
  2. Be intelligent and help each and every staff member. For example, Google™ search learns each and every user’s behavior and remembers patterns to reduce data entry. It auto-learns and auto-suggests saving time and effort. Similarly EHR software, using these features, can auto-populate frequently used information. For example, an intelligent EHR will learn and can help nurses auto-populate frequently used diagnoses, medications, allergies, immunizations and phrases. Let intelligent technology be a friend of the EHR users and reduce the burden of data entry. After all, staff wants to spend time with patients and not computers.
  3. Be built specifically for YOU. Many EHR programs are general purpose and try to serve many clinic types. If you are a local health department, you know that you have similarities with primary care but you are keenly aware that there are significant differences as well. An EHR which works well for a particular practice may not necessarily work well for you.

Workflow: This area is important to understand before moving forward with a selected EHR system. Will the new system disrupt your department, or assist in its operations. If the EHR system is not designed for your type of clinic, chances are it will be very disruptive to your organization workflow. For example, during patient check in process, a local health department collects household income which is used for sliding fee scale. If the primary care EHR does not support program-specific sliding fee scales, you will need to do manual workaround to make that EHR work. Similarly, if your EHR does not have built-in communicable disease capability, tracking TB patient contacts will complicate your workflow. Without the right EHR, your organization will end up working around your EHR (with manual workarounds) resulting in data being dispersed (in a mix of paper and electronic systems) and, eventually, staff will stop using the EHR.


People feel more at ease with familiarity. If the EHR workflow is optimized for your clinic type, it will of course minimize the learning curve and increase adoption speed by your staff.

6 Ways to Optimize Your EHR

optimize for EHR success with your EHR vendor

Whether you are moving from paper, a hybrid system or an existing EHR, now is the time to think about how to optimize your EHR. It’s not an easy task. It has a lot of moving parts. But, putting this effort in before you search for an EHR vendor and implement a system is key to your success.

1. Make it a Collaborative Effort

EHR optimization is a collaborative effort. All of your key stakeholders should be involved. This includes personnel from billing, program management, practice administration and clinical. However, don’t forget to include your EHR vendor in this list. They will help you work through this process and help provide insight and best practices.

2. Re-imagine your Operations

Begin by re-imagining your day-to-day operations with technology in mind. For instance, if you used to pull and file charts, how would you do that differently with electronic files? What are your patient-centric activities? Then, think about how these activities can be streamlined so you can provide more effective patient care. This is where you begin developing your workflows. Believe it or not, your EHR can be optimized to follow your organization’s processes.

3. Go beyond the Basics with Documentation

Go beyond the basics. What works and what doesn’t work for your organization? What information do you need for every client? Are there things that can be templatized to make your process more streamlined? Do you need check boxes or free text? Also, think about how your current documentation processes can be improved and work those changes into how your EHR functions.

4. Really Think about your EHR Workflow

Just because you’ve always done it a certain way doesn’t mean you should continue with it. People moving from paper often try to recreate their workflow in their EHR. But, if you are trying to leverage the value of an electronic system, you should consider how your organization can capitalize on that functionality. Think about the possibilities of how your clinic can function now that information is available for any authorized staff member.

5. Keep your Eye on the Bottomline

Cash flow and revenue cycle management can be a real business issue. Create goals or benchmarks for your key financial performance metrics, and use your integrated EHR system to monitor critical reports on a regular basis. In addition, you can share results with the entire team around daily collections, insurance claims outstanding, and your insurance Aging Report. When practice management, electronic health records and billing systems are integrated, you will see a direct impact on your revenue. You’ll begin seeing increase cash collections, a decrease in aging and better reporting for earning government funding.

6. Personalize. Configure. Customize.

Think about how your solution can be tailored for your organization. For example, how can your EHR be personalized for your users so they only see the information that’s relevant to their role? Similarly, how can it be configured with your programs, templates and forms? And, as often is necessary, how can your EHR be customized to meet your unique needs?

As you’re on your journey to implement an EHR that is optimized for your organization, ensure you select a vendor that will truly be a partner for you. One who will help you implement best practices for clinical workflows that meet the needs of your care setting. Optimizing your EHR will help you improve quality of care while also improving your team’s productivity. It’s a win-win.

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